1245556091 NPI number — HEALTHONE CLINIC SERVICES - ORTHOPEDIC SPECIALISTS LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245556091 NPI number — HEALTHONE CLINIC SERVICES - ORTHOPEDIC SPECIALISTS LLC

Employer Identification Number (EIN):

Provider Organization Name:

HEALTHONE CLINIC SERVICES - ORTHOPEDIC SPECIALISTS LLC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

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Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1245556091

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

01/02/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2000 HEALTH PARK DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BRENTWOOD

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37027-4692

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

615-373-7600

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

11230 BENTON ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WESTMINSTER

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80020-3275

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

303-453-2997

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/19/2010

Authorized Official Last Name:

REBOK

Authorized Official First Name:

JOHN

Authorized Official Middle Name:

Authorized Official Title or Position:

VP

Authorized Official Telephone Number:

615-372-5004

• Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 94473889 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 94922080 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1245556091 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 56473362 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 57327262 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 129802000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 200685190B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 38882388 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 68975287 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 14203286 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1245556091 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 23752581 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 96071389 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".